Maternity referrals

Inclusion criteria

Any of the following:

• The Women’s is the patient’s closest maternity service
• Maternal medical or fetal complexity and the Women’s is the patient’s closest tertiary maternity service. Other Victorian Level 6 maternity services: Mercy Hospital for Women, Monash Health and Joan Kirner Women’s and Children’s Hospital.

We accept referrals for the following patients, even if the Women’s is not their closest service (please indicate in referral):

• Aboriginal or Torres Strait Islander patients (Baggarrook midwifery care)
• women with a disability (Women with Individual Needs Clinic)
• patients experiencing homelessness (The Cornelia Program)
• patients with complex needs and/or co-morbidities (determined by clinical triage upon receipt of a referral).

Early referral (Complex needs, Genetics)

For most women, we request a referral at 12-13 weeks. However, please send a maternity referral earlier in pregnancy in the following circumstances:

• familial genetic conditions
• maternal medical complications likely to impact pregnancy
• multiple pregnancy
• previous complex obstetric history (see referral form)
• psychotropic medicine use
• screening tests or ultrasound scans indicating increased risk of a fetal complication.

With early referral, there is no need to wait for all pathology and ultrasound investigations to be completed before referring.

Minimum referral information

Unless your patient is high risk and requires an early referral, please refer at 12-13 weeks when routine pathology and 12 week scan results are available to include with the referral.

The timing of referral has no impact on their allocation to a maternity model of care. This is determined at the booking appointment (around 16-18 weeks if not high risk).

We require the information listed below to appropriately triage your referral, allocate your patient to a suitable clinic, and contact them about their appointment.

Sharing results

In addition to including results with the referral, please also copy investigations to the Women’s (as this sometimes enables automatic upload to a patient’s electronic record). In the CC section, add the following codes:

• Australian Clinical Labs: RWH
• Melbourne Pathology: RWH
• Dorevitch: #RWH

Please give the patient a copy of all results and ask them to bring this to their first appointment at the Women’s. We encourage patients to have a My Health Record and to sign up for the Parkville patient portal Health Hub (after their booking visit).

Make a referral

Fax referrals to the Women’s Fast Fax: (03) 8345 3036.

If faxing is not an option for your clinic, or you have problems with fax referrals not being received, please email our GP Liaison Unit for assistance. Do not include your referral in this email. Email: GP.liaison@thewomens.org.au

The use of templates is encouraged – jump to Referral templates (Downloads).

If you are a GP and do not receive a letter in 1 to 2 weeks that your referral has been accepted/declined, contact the Access Centre (GP use only): (03) 8345 2058, option 2.

Referrers are responsible for obtaining patient consent for referral and sharing sensitive, personal and health information with us. Following triage assessment, we may redirect your referral to a more suitable public health service. Please let us know if your patient does not consent to this.

In detail: How referrals are processed

Genetic screening/testing

Reproductive carrier screening

Information about carrier screening should be provided to all women or couples during pre-conception and early pregnancy.

MBS supports testing once in a lifetime for all Medicare-eligible individuals who are pregnant or are planning a pregnancy, and their reproductive partners. The rebate covers genetic reproductive carrier testing for cystic fibrosis (CF), spinal muscular atrophy (SMA) and fragile X syndrome (FXS).

Down syndrome testing

Discuss Down syndrome testing with your patient and arrange if appropriate. Common screening:

• non-invasive Prenatal Testing (NIPT) for cell-free fetal DNA at about 12 weeks, or
• early combined screening test (blood test in 10th week and ultrasound at 12 weeks) or a maternal serum screening test at 15-17 weeks.

If personal or family history, screening, testing or ultrasound identifies a pregnancy as having a risk of a genetic condition, refer the patient to the Women’s Genetics (Clinical) Service.

Ultrasound scans

The Women’s has limited ability to provide routine ultrasound scans. Please organise the following ultrasounds in the community and provide the results to your patient:

• 12 week ultrasound (nuchal translucency and dating)
• 20-22 week ultrasound (fetal morphology) – this will only be undertaken at the Women’s for some high risk women.

If there is an abnormality or you require advice, please re-refer with the results.

Additional growth scans and/or placental positional scans will be arranged by the hospital if indicated. At the Women’s, a scan for fetal position is usually performed at the bedside as a point of care test at 36 weeks.

After referral

Please continue to see your patient and arrange the relevant tests while they are waiting for their first appointment at the Women’s.

New investigations or change after referral

It is the referrer’s responsibility to monitor the patient’s condition and notify us if there is a change that could affect the urgency of treatment, or the care required.

Circumstance	Recommendation
If the patient’s condition deteriorates or changes, or there are investigations that require hospital clinical review or a more urgent appointment	Re-refer them with additional information and new/more recent investigations (if applicable). Indicate this is a re-referral and mark ‘URGENT’ if relevant.
If results do not require review prior to the patient’s next appointment	Fax results for upload to the patient electronic medical record to F: (03) 8345 3036. In this case, results will not be reviewed by the hospital until the patient’s next appointment.
For immediate assessment and care, or after-hours support	Consider the most appropriate of: Women’s Emergency Care or closest public emergency department Early Pregnancy Assessment Service phone the Women’s switchboard on (03) 8345 2000 and ask to speak with the Obstetric Consultant phone Healthdirect on 1800 022 222 Victorian Virtual Emergency Department

Miscarriage

If your patient has a miscarriage, please let us know so we can cancel their appointments and avoid causing additional distress. Notify us by sending a letter to our Access Centre by Fast Fax: (03) 8345 3036.

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